Evolution and Impact of U.S Health Care Policies

Health care policy changes have played a massive role in the United States for nearly a decade, from the 1930s New Deal programs to the creation of Medicare and Medicaid in 1965. The most recent legislation called for a national reform to health insurance; however, where Medicare was included in the initial reform, Medicaid relies on individual states to expand their programs. With the enactment of the Affordable Care Act, no discrimination against individuals with preexisting conditions has allowed many uninsured to become eligible for subsidized insurance or Medicaid; especially people living with HIV and AIDS. According to Rushefsky, “There are four generic goals that are the focus of health care policy: security, equity, efficiency,

Rushefsky describes five policy tools: direct provision of services, rules, inducements and incentives, facts and persuasion, and the use of powers. Direct provision of services includes those services that are directly run by the government, like the VA hospitals and clinics. The second tool, rules, relates to the payment system of services “as to who may provide such services, how they may be provided, what services will be provided, how they shall be financed, and who is eligible (Rushefsky 180).” The next tool used in health policy is the use of inducements and incentives. Rushefsky describes that an example of an incentive is student loan forgiveness for new doctors who work over a period of time in an area with limited services, requiring medical assistance. He also describes an inducement for Medicare where hospitals are given a set amount of money for a specific diagnosis, thus the goal of this inducement to reduce a patient’s stay and cut off spending to a degree where the patient pays after a certain point. The fourth tool is the uses of facts or persuasion in order to promote smart use or changes of the use of different substances like cigarettes, alcohol, and drug use. The final tool used in health care is the use of powers, where there are two ideals whether states or the federal government should decide on reform and to what extent health services be provided by the

The Ryan White Comprehensive AIDS Resources Emergency Act was founded in 1990 and aims to assist people living with HIV/AIDS, particularly those who are low-income, uninsured, and underinsured individuals. With the Affordable Care Act extending coverage, “thousands of people living with HIV who have received Ryan White HIV/AIDS Program-funded care are now eligible for Medicaid or subsidized insurance (Cahill et al. 1).” However, the authors argue that the program is still essential as many services are not covered by any other sources. The services not covered by other sources include: “case management, treatment adherence counseling, housing support and advocacy, some kinds of HIV prevention and testing outreach in nontraditional settings, legal services and advocacy to help people newly diagnosed with HIV and AIDS access benefits, food and nutrition services, dental services, transportation, peer support, risk reduction counselling, and some mental health services (Cahill et al. 1 &